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Objectives Quantify the effects of head rotation and head incline on obstructive sleep apnea (OSA) severity. Design Single-arm, intervention study. Setting Pulmonary specialty clinic. Case presentation Ten adults diagnosed with positional OSA ranging from 32 to 64 years of age 6 females, 4 males reporting persistent daytime sleepiness and health issues with consistent use of CPAP. Intervention Standard polysomnography with a head angle sensor attached to the forehead and coaching to fall asleep with head at various rotation and incline angles and torso in supine and non-supine positions. Measurements OSA severity was scored according to American Academy of Sleep Medicine guidelines. Apnea hypopnea index (AHI) and peripheral capillary oxygen (SpO 2 ) saturation were measured during each sleep epoch of unique head rotation, head incline, and torso position. Results Two participants (1 with no apneas and 1 with central sleep apnea) were excluded. Among the remaining 8 participants, average reduction in peak AHI was 66% (range 18–88%) with head rotation ≤ 20° above the horizon compared with &gt; 20° above the horizon. The average of peak AHI values with head rotation ≤ 20° was significantly lower than with head rotation &gt; 20° (20.0 vs 45.3,  P  = 0.002). Minimum SpO 2  was significantly higher for head rotation ≤ 20° compared with &gt; 20° (mean: 90.6% vs 84.3%,  P  = 0.03). In the torso supine position, average peak AHI was significantly lower with head rotation ≤ 20° compared with &gt; 20° (7.1 vs 52.1,  P  &lt; 0.001). In the torso non-supine position, lower average peak AHI with head rotation ≤ 20° was not statistically significant (22.3 vs 38.4,  P  = 0.09). Conclusion These results support further exploration of maintaining head position ≤ 20° above the horizon to minimize AHI and oxygen desaturation in OSA patients. Trial registration Apnea Hypopnea Index Severity Versus Head Position During Sleep. ClinicalTrials.gov Identifier: NCT04086407 September 11, 2019 Registered retrospectively.

Quantitative effects of head rotation angle on apnea hypopnea index in positional obstructive sleep apnea – a preliminary case series